HomeMy WebLinkAbout10044 Adams Ave - CofO (2)Certificate of Occupancy No. 0200q-0 3 j
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON -BEACH - DEPT. OF BUILDING & SAFETY
' (3`4 Floor - Must Apply In -Person)
Business License Yl A-A-1-5 01`:5 -4- Date O
Business Address W Qq{ AD#b'y\S AyE, 4-1V, q,904 Zip Code
Business Owners Name r-E, V I N Le Telephone No.
Business Name M V 1 N L & BTIV O1 t3 Bus. Phone
Business Type ?tin -rib crgftmy
Property Owner Information required) Tenant/Emergency Contact (required)
Nameda-VName
Address r Home Address
City ,Ti�,r ;u D State/Zip City `ate/Zip �q 1/6_
Telephone No. Telephone No. �� f� l CI - %3 d
THIS USE W PULD)BE D SCRIBED AS:
❑ Newly Constructed Building or Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner Chane of Occupant ❑ Change of Use ❑
■ Indicate former type of business
■ Are you requesting that the electricity be turned o . YesONo❑
■ Is the building sprinklered? Yes )2No11
■ Will operations produce dust/wood'shavings or similar material? . YesONo
■ Will operations involve the repair or replacement of automobile parts Yes QNV§
Additional Occupant
If yes: Describe the
components repaired or replaced.
Does the operation involve the use of welding or open flame? Yes UNo�D
Will the business be a. drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ONo [
The following best describes My operation: ❑ Office Only . Retail Sales ❑ Medical/Dental
❑ Restaurant/Take Out Food ❑ Warehouse /Manufacturi
(describe process.an
'Other (describe)
For Official Use Onl
Occ Group:
Occ Group:
Area:
Area:
Occ Group: Area:
Total Sq Ft Occupied: I Qq 0 No. of Stories:
Bldg. Permit # Entitlement #:
Plnr Initials: Date:( Plan Chkr Initials:
Conditions of Approval or Other Notes:
Frm l t. L' 5s (PVKA ff�ft .
Occ Load: 10
Occ Load:
Occ Load:
TIF Review: Y
Zoning: C
Dater Insp Initials: Date:
Inspection Date:
(G:Building/Forms/document id goes here)
--tea
t Y�South Coast
Air Quality Management District
21865 E. Copley Drive
Diamond Bar, CA 91765-4182
(909) 396-3529 htpp://www.agmd.gov
Air Quality Permit Checklist
California Government Code 65850.2 prohibits cities from issuing a Certificate of Occupancy to a business without
clearance from the local air quality agency. This checklist will determine if you need to obtain clearance from the
South Coast Air Quality Management District (AQMD).
Company Name: gfcU /N Le 5-F0 V 1 O
Property Address: / 0p14 1-% PrOA-ES S A,16 -H 25 %'�4 .C'
City: Zip Code: C'60�'
Contact Person: ���� Title:
Type of Business: Telephone:() —
11
Applicant: (print name) 4F V /A) LE- Signature:
Cl Will the facility have any of the following equipment? Yes ONo
Charbroiler
Dry cleaning machine
Spray Booth
Printing Press (screen/lithographic/flexographic)
Internal combustion engine (greater than 50HP) (excluding motor vehicles)
Boiler/combustion equipment (greater than 2 million BTU/hr. maximum input)
Abrasive blasting cabinet/room
Baghouse/cartridge type dust filter/scrubber
Motor fuel storage and dispensing equipment
Q Will any of the following operations be performed? Yes E]No
Application of paints or adhesives
Etching, plating, casting; or melting of metals
Molding and blending of liquids and/or powders
Storage of acids, solvents, organic liquids or fuels
Production of acids, solvents, organic liquids, or fuels
Production of fumes, dust, smoke or strong odors
f you answered "No" to both questions, this checklist is your clearance from AQMD.
�] If you answered "Yes" to either question, you must contact AQMD to determine if air quality permits are required.
If permits are needed, AQMD will assist you in submitting permit application(s) and then provide you with a
clearance letter. You can call AQMD at their Small Business Assistance Office at (800) 388-2121.